Additional May 28 Boston HAN meeting notes

Please note: the following is only the second part of our May 28 Boston HAN meeting notes.

Report on Network Standards in Commonwealth Care

Marcy Ravech, who often attends our meetings representing the Blue Cross Blue Shield of Massachusetts Foundation, officially introduced "Network Adequacy in the Commonwealth Care Program," (PDF) a new Foundation study conducted by Bailit Health Purchasing. Marcy emphasized that the impetus for the study came from concerns outreach workers raised at HAN meetings about clients’ access to providers. She also noted this meeting’s discussion of coverage gaps suffered by seasonal workers for possible future investigation.

Meryl Price of Health Policy Matters, who consulted for Bailit on this project, stressed that the study focuses on the adequacy of Commonwealth Care standards for such things as patient/provider ratios, waiting times for appointments, travel distance to services, and the complaint process. It does not indicate whether or not the access standards are adequately serving members’ needs in practice.

In general, the study found:

• that access issues for Commonwealth Care enrollees are no different from those experienced by anyone on MassHealth or with a private policy: a shortage of providers (particularly primary care), long waiting times for appointments (particularly acute in Western Massachusetts and the Cape and Islands), access to specialists
• that all CommCare members are assigned to a PCP per requirements
• that MCOs and networks are meeting cultural and linguistic needs
• that CHCs are having difficulty making referrals to usual sources of care where specialists and/or hospitals don’t participate in MCO networks
• members aren’t filing that many formal complaints with either the MCOs or the Connector, but they do complain informally to providers

Bailit team recommendations to the Connector include:

• conducting an analysis of provider overlap between plans – possibly considering requiring some level of safety net providers within network, or using the MassHealth PCP plan in limited circumstances to ensure appropriate access
• working with plans, providers and advocates to develop a better system for collecting information about members’ ability to access care, including getting information directly from members
• working closely with plans, especially new MCOs, to ensure network adequacy and make sure they understand members’ cultural and linguistic needs
• monitor the impact of state budget cuts on Commonwealth Care, including enrollment and access

One HAN member noted the difficulty clients have in making an informed choice during Open Enrollment when a new low-priced MCO is operating in their region, but they don’t yet know who the providers will be. Another observed that clients who have had experience with employer-sponsored insurance are very satisfied with Commonwealth Care; it’s people transitioning into it from MassHealth who have the most trouble coping with their new roles as consumers.

Policy Updates from Health Care For All

Kate Bicego, manager of the Helpline at Health Care For All, discussed some recent ACT!! Coalition wins and losses in the state’s ongoing FY 2010 budget process.

Please note: On June 29, Governor Patrick signed most of the conference committee budget into law, with vetoes. One of these vetoes eliminates the requirement that off-budget sources contribute $2.5 million for outreach and enrollment grants; another proposes $70 million to continue health coverage for legal immigrants. For details, please see Brian Rosman's June 29 blog post, "The Budget and the Pen." What follows is the background information Kate gave us, with some updates:

Immigrants on Commonwealth Care

• Under the Senate’s budget proposal, 28,000 "special status" immigrants would lose their eligibility for Commonwealth Care—that’s 15% of the CommCare population. CP Update 6/29: Though this cut was adopted by the Conference Committee on June 19, the Governor partially vetoed it on June 29. Please see Brian Rosman's blog post for an analysis of the Governor's counter-proposal, which does not keep this population directly covered by Commonwealth Care.

Outreach grants:

• Outreach grants were partially restored by the Senate budget, with funding from off-budget sources. CP Update 6/29: The Governor's vetoes eliminate the Senate's proposal, which directed the Massachusetts Health and Educational Facilities Authority (HEFA) and the Commonwealth Connector to fund outreach and enrollment at $2.5 million; the Governor proposes no funding for outreach. (Level-funding would have been $3.5 million.)

FMAP funding

• Advocates wanted the federal Medicaid reimbursement money Massachusetts receives (called FMAP) to go directly to restoring health care cuts – but that provision was not included in the Senate budget and is not expected to be included in the final budget.

And, finally, some good news:

• Many cuts to services and eligibility that were initially proposed were reversed as part of the decision to raise the sales tax to 6.25%. Some of the funding that was at least partially restored includes MassHealth dental care, services to people with developmental disabilities, and Prescription Advantage.

As of this meeting, the state budget was in the Conference Committee, which is made up of both House and Senate members and which must agree on a final version of the legislative budget to present to Governor Patrick. (Note: This final version was presented to the Governor on June 19 and was signed into law with vetoes on June 29.)